Background Since 2000, the widespread adoption of pneumococcal conjugate vaccines (PCVs) has had a major impact in the prevention of pneumonia. Limited access to international financial support means some middle-income countries (MICs) are trailing in the widespread use of PCVs. We review the status of PCV implementation, and discuss any needs and gaps related to low levels of PCV implementation in MICs, with analysis of possible solutions to strengthen the PCV implementation process in MICs. Main body We searched PubMed, PubMed Central, Ovid MEDLINE, and SCOPUS databases using search terms related to pneumococcal immunization, governmental health policy or programmes, and MICs. Two authors independently reviewed the full text of the references, which were assessed for eligibility using pre-defined inclusion and exclusion criteria. The search terms identified 1,165 articles and the full texts of 21 were assessed for suitability, with eight articles included in the systematic review. MICs are implementing PCVs at a slower rate than donor-funded low-income countries and wealthier developed countries. A significant difference in the uptake of PCV in lower middle-income countries (LMICs) (71%) and upper middle-income countries (UMICs) (48%) is largely due to an unsuccessful process of "graduation" of MICs from GAVI assistance, an issue that arises as countries cross the income eligibility threshold and are no longer eligible to receive the same levels of financial assistance. A lack of country-specific data on disease burden, a lack of local expertise in economic evaluation, and the cost of PCV were identified as the leading causes of the slow uptake of PCVs in MICs. Potential solutions mentioned in the reviewed papers include the use of vaccine cost-effectiveness analysis and the provision of economic evidence to strengthen decision-making, the evaluation of the burden of disease, and post-introduction surveillance to monitor vaccine impact. Conclusion The global community needs to recognise the impediments to vaccine introduction into MICs. Improving PCV access could help decrease the incidence of pneumonia and reduce the selection pressure for pneumococcal antimicrobial resistance.
Trapped in the Middle? investigates whether middle-income traps really exist and, in case they do, how these pitfalls are manifested, their causes, what economic policy measures are required to escape from them, and what international cooperation can do to support this process.
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A standard DSGE small open economy model can not generate the cyclical regularities of middle-income countries. It predicts excessive consumption smoothing, and procyclical, instead of countercyclical, real net exports. Previous studies have solved this problem by increasing the shocks' persistence or by lowering the intertemporal elasticity of substitution. This paper tackles the problem by introducing market imperfections relevant for MICs into an otherwise standard model. More specifically, I build a model with limited access to the foreign capital market, identified as an external borrowin
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In: Rathod , S , Pinninti , N , Irfan , M , Gorczynski , P , Rathod , P , Gega , L & Naeem , F 2017 , ' Mental health service provision in low and middle income countries ' Health Services Insights , vol 10 , pp. 1-7 . DOI:10.1177/1178632917694350
This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics–how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.
At a time of growing inequality and under-investment in public infrastructure, my re- search has focused on understanding governments' constraints in raising tax revenue and providing redistribution. These challenges are particularly important for low and middle- income countries: despite improvements in their institutional capacity in the last decades, their ratios of tax revenue to GDP remain much lower than OECD countries' (Besley and Persson 2013a), and their tax and transfer systems are often distributionally neutral, instead of progressive.In the first chapter, I ask whether developing countries with limited information and tax capacity can use the corporate income tax to raise additional revenue, and design it optimally given these constraints. I explore this question for Costa Rica, using the universe of corporate tax returns and a novel methodology which exploits the country's unique tax design: firms with marginally different revenue face discontinuously higher average tax rates. This notch feature allows me to first estimate the elasticity of profits with respect to the tax rate, and second to separate it into its components, namely the revenue and cost elasticities. I find that firms facing a higher tax rate slightly decrease reported revenue, but considerably increase reported costs, leading to a large drop in reported profits. Using additional data sources, firms' behavioral responses appear to occur through tax evasion, with no evidence of production responses. Taken together, this implies that Costa Rican firms evade taxes on a massive 70% of their profits when faced with a 30% tax rate. In this context, lowering corporate tax rates could increase tax revenue, since we estimate the revenue maximizing rate to be below 25%. Alternative tax rules, that limit the deductibility of costs could be preferable since they would reduce evasion opportunities on this crucial margin. The results highlight the limitations of standard business taxation as an instrument to raise revenue in developing countries.The first chapter points to limitations for revenue collection, when given the current enforcement environment. In the Second Chapter, I study how third-party information might spread to the government, in order to improve tax enforcement. Firm level tax compliance depends on the stock of information accessible to the government. Theoretical work(Gordon and Li 2009b, Kleven, Kreiner, and Saez 2016) highlights two specific information trails: access to formal finance and the number of employees. I test whether firms with more employees and with access to formal finance are more likely to be audited and less prone to evading taxes. I use firm-level data on 108,000 firms across 79 countries in the World Bank Enterprise Surveys and construct instruments for finance and worker-size at the industry level, using an out of sample extrapolation strategy related to Rajan and Zingales (1998). The instruments isolate variation in industry technological demand for labour and formal finance by taking the US industry distributions as undistorted benchmarks. I find that firms with more employees are more likely to be audited and to comply, but find no evidence that firms using the financial sector are under higher scrutiny.Finally, in the third chapter, I turn to the redistributive role of governments, and study how a new technology to deliver cash transfers can be used to impact transfer beneficiaries' trust in financial institutions and their savings behavior. It is well documented that trust is an essential element of economic transactions, however trust in financial institutions is especially low among the poor, which may explain in part why the poor do not save formally. Debit cards provide not only easier access to savings (at any bank's ATM as opposed to the nearest bank branch), but also a mechanism to monitor bank account balances and thereby build trust in financial institutions. I study a natural experiment in which debit cards were rolled out to beneficiaries of a Mexican conditional cash transfer program, who were already receiving their transfers in savings accounts through a government bank. Using administrative data on transactions and balances in over 300,000 bank accounts over four years, I find that after receiving a debit card, the transfer recipients do not increase their savings for the first 6 months, but after this initial period, they begin saving and their marginal propensity to save increases over time. During this initial period, however, they use the card to check their balances frequently; the number of times they check their balances decreases over time as their reported trust in the bank increases. Using household survey panel data, I find the observed effect represents an increase in overall savings, rather than shifting savings; I also find that consumption of temptation goods (alcohol, tobacco, and sugar) falls, providing evidence that saving informally is difficult and the use of financial institutions to save helps solve self-control problems.
AbstractThe current challenge of education systems is learning. Across low-income countries (LICs) and lower-middle-income countries (LMCs), 62 % of 10-year-olds could not read at a minimally sufficient level in 2015. This study provides an overview of recent spending on education and its correlation with learning outcomes. We show that the relationship between education spending and learning is historically weak. From 2000 to 2015, LICs and LMCs increased spending on education in primary schools by ~$137 per student, an 80 % inflation-adjusted increase, with no corresponding change on the average learning outcomes. We then conduct a benefit-cost analysis of candidate interventions that could increase learning at low cost. Two interventions – structured pedagogy and, teaching at the right level, with and without a technology component generate large benefit-cost ratios. If deployed uniformly to reach 90 % of the 467 million students in LICs and LMCs, these interventions would cost on average $18 per student per year or $7.6 billion annually, generating $65 in benefits for every $1 spent. The economic logic behind this finding is that the hard and costly work of getting children into primary schools has mostly been accomplished, leaving open the possibility of learning interventions that improve the efficiency of the existing education system at low cost. Our results show that increasing education expenditure by just 6 % could increase learning by 120 % if directed toward these highly cost-effective interventions.
In: The European journal of development research: journal of the European Association of Development Research and Training Institutes (EADI), Band 15, Heft 1